Detail (Long)
<b>Mammography harms:</b><sup>3,11</sup><br>
◦ Over-dx + over-tx of insignificant CAs that would not have caused sx or death; 20% to 50% of screen-detected breast CAs are overdiagnosed based on pt age, life expectancy, and tumor type (ductal carcinoma <i>in situ</i> and/or invasive).<br>
◦ False(+) w/ additional tests, anxiety; 10% of pts will be recalled from each screening exam for further tests; only 5 of 100 recalled will have CA. Approx 50% of pts screened annually x10y in the U.S. will experience a false(+), of whom 7% to 17% will undergo bx. Additional testing less likely when prior mammograms available for comparison.<br>
◦ False(-) w/ false security, potential dx delay; 6% to 46% of pts w/ invasive CA have neg mammogram, esp. if young, dense breasts, or mucinous, lobular, or rapidly growing CA.<br>
◦ Radiation-induced breast CA; radiation-induced mutations can cause breast CA but w/ radiation doses higher than those used in a single mammography exam. Dose for typical 2-view mammogram is extremely unlikely to cause CA. Theoretically, annual mammography in pts 40-80 yo may cause up to 1 breast CA per 1,000 pts.
◦ Over-dx + over-tx of insignificant CAs that would not have caused sx or death; 20% to 50% of screen-detected breast CAs are overdiagnosed based on pt age, life expectancy, and tumor type (ductal carcinoma <i>in situ</i> and/or invasive).<br>
◦ False(+) w/ additional tests, anxiety; 10% of pts will be recalled from each screening exam for further tests; only 5 of 100 recalled will have CA. Approx 50% of pts screened annually x10y in the U.S. will experience a false(+), of whom 7% to 17% will undergo bx. Additional testing less likely when prior mammograms available for comparison.<br>
◦ False(-) w/ false security, potential dx delay; 6% to 46% of pts w/ invasive CA have neg mammogram, esp. if young, dense breasts, or mucinous, lobular, or rapidly growing CA.<br>
◦ Radiation-induced breast CA; radiation-induced mutations can cause breast CA but w/ radiation doses higher than those used in a single mammography exam. Dose for typical 2-view mammogram is extremely unlikely to cause CA. Theoretically, annual mammography in pts 40-80 yo may cause up to 1 breast CA per 1,000 pts.